Healthy Homes in Knowsley - Healthy Homes in ...
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Healthy Homes in Knowsley
Housing and health • The average person spends around 2/3 of their time at home (ONS, Time use survey 2005) • Long established link between poor housing and poor health Direct links: Indirect links: – Excess winter deaths – Crime/ASB – Cardiovascular disease – Educational attainment – Respiratory disease – Employment opportunities – Poor mental health – Community cohesion – Accidents e.g. trips/falls • Estimated cost to NHS of treating ill-health resulting from sub-standard housing - £2.4bn/yr (NFH, 1997) • Estimated cost of asthma - £847m/yr (Brambleby et al, 2008) • Estimated cost of hip fractures to society around £726 million/yr (University of York, 2000)
Social Isolation
• Loneliness and physical health
– The effect of loneliness and isolation on mortality exceeds the impact of well-
known risk factors such as obesity, and has a similar influence as cigarette
smoking (Holt-Lunstad, 2010)
– Loneliness increases the risk of high blood pressure (Hawkley et al, 2010)
– Lonely individuals are also at higher risk of the onset of disability (Lund et al, 2010)
• Loneliness and mental health
– Loneliness puts individuals at greater risk of cognitive decline (James et al, 2011)
– One study concludes lonely people have a 64% increased chance of developing
clinical dementia (Holwerda et al, 2012)
– Lonely individuals are more prone to depression (Cacioppo et al, 2006) (Green et al, 1992)
– Loneliness and low social interaction are predictive of suicide in older age
(O’Connell et al, 2004)
The bad news – Knowsley by numbers
• Approx 64,500 dwellings
• Majority built 1920s onwards, as a result of Liverpool overspill
• Disproportionate level of 3 bed post war properties
• Over next 10 years, proportion of 85+ increase by 1,900 people (a 78% increase)
• 2nd most deprived Local Authority in the country – ‘running to just stand still’ (2015 data)
• 18% of properties contain a Category 1 hazard (2011 data)
• Highest rate of mortality from Chronic Obstructive Pulmonary Disease (COPD) in
England, (almost twice average rate for England)
• Between 2008-2010 Knowsley had the 21st highest mortality rate from Cardio
Vascular Disease (CVD) in England
• Welfare reforms inc. bedroom tax and benefits cap
• 23.4% of households (14,500) facing fuel poverty and rising energy prices (2011)
• 44% of all properties are ‘low income households’ (English average - 33%)
• Reducing household income – benefits cuts, tax credits
Knowsley Nationally
Owner occupied 62.30% 64.20%
Social housing 26.60% 17.70%
Private rented 9.7% 16.60%
Other 1.40% 1.50%
Additional challenges
• Vulnerable residents not engaging & accessing services earlier enough
• Services not engaging with the residents needing support (cultural barriers)
• Most services designed from a traditional approach ‘of doing to / for’
• Services are static – clients expected to go to them
So what does this result in?
• Problems grow (become more difficult to resolve and most expensive)
• Lack of social mobility – reduces engagement
• Services inflexible – limited uptake
• No real engagement – which maintains a dependence culture
• Fantastically designed services, that no-one knows about or accesses
Greater cost to public finances!
What is Healthy Homes?
Purpose
Target areas of poor quality housing and health via a team of trained Advocates to engage
with residents and undertake a survey of both the well being householders and the
physical aspects of the home.
Overall aim:
‘Prevention of physical and mental illness, reducing long term costs to society’
Deliver model
Bring the service to the people, by door knocking 32,000 properties within 2 years.
Process
1. Have a chat with residents about condition of their property & range of other issues
affecting their health and wellbeing.
2. Make referrals via tablet computer to 17 different partners regarding:
• Access to health care and lifestyle services • Income maximisation & employment advice
• Support services • Home safety
• Housing condition • Safeguarding
• Energy efficiency and fuel poverty • Community activities
What we are finding
The story so far...
• Completed 1st year (2 years funding)
• Door knocked almost 12,000 properties
• Completed over 1100 surveys
• Generated over 3500 referrals
• Increasing word of mouth = more interviews
(over 50% surveys are now via appointments)
• Expanding and developing the services with new partners
• Direct referrals routes from COPD Nurses and GPs
• Promoting service on a wider scale
• New projects work with Police and Children Centres.
• Establishing good links with community stakeholders
Numbers of referrals
Number of Number of
Partner Agency/Service Partner Agency/Service
referrals referrals
Debt and Welfare Advice
Strategic Housing &
433 via Citizens Advice 210
Environmental Health
Bureau
Children Centre 120 Merseyside Fire Service 654
Knowsley Works 56 Merseyside Police 238
Benefits Team 72 Health Trainers 199
Knowsley Access Team
24 Energy Efficiency Advice 366
(KAT)
IKAN 161 Care & Repair Service 121
Community Messaging 300 Early Help 14
Anti Social Behaviour
Discretionary Support 12 Unit 25
*No longer a referral route.*
Housing - Issue Types
Position and operability of Asbestos and MMF Carbon monoxide and fuel
amenities etc. 2% combustion products
Personal hygiene, 3%
Sanitation and 1%
Structural
Drainage Collision and entrapment
collapse and
4% 1%
falling
Flames, hot surfaces etc elements
Food
1% 6%
safety
4%
Fire
3% Damp and mould growth
Falling on stairs etc 15%
4%
Falling on level surfaces etc
5% Electrical hazards
12%
Falling between levels
1% Explosions
3%
Entry by intruders
8%
Excess cold
29%Case Studies
The good news – initial findings General • Each survey is producing on average 3 referrals. (Record is 8). • Surveys normally take on average 25 minutes. (Record is 4 hours - quality not quantity) • Debt issues mainly women, living on their own, in social rented property living on benefits/sickness benefits. 40% of all queries were benefit related. • 2/3 of people seen were women. • 2/3 of people surveyed are experiencing improved mental well being. (SWEMWEBS) Property • Main property profile types are mid-terraced or semi detached houses, built during 1946-79 period. • On average finding x2 hazards per property. Finances • For every £1 spent with Citizens Advice Bureau = achieving benefits worth £10. • 25% of CAB referrals successfully offered ‘self help’ – reducing future demand. • Home energy help averages saving £150 per household. • 9 x Improvement Grants fully completed (cost of £40,000 – ‘paid back’ within 1st year) • Further 37 grants being processed, with another year to run. • So far ‘Social Value’ in excess of £500k.
Our key learning
1. The reality is different to the theory
2. Community Engagement vital
• Vary approaches
• Do community values match service values?
• Staff continuity crucial
3. Outcomes can be hard to prove
• Mental health
• ‘Social value’ point of view
4. Men can be difficult to find and engage with
• Flexible approaches needed
5. Justifying the expenditure and ‘proving the savings’
6. Sustainability/Legacy Plan increasingly difficultThe power of 1 visit - Ted & Brenda
Thank you for your time
Steve Gowland
Lead for Healthy Homes in Knowsley
0151 443 5208 or 07766725281
steve.gowland@knowsley.gov.uk
0800 694 0370 or healthyhome@knowsley.gov.ukYou can also read
